Contact

Teri Williams

Public Information Officer

(702) 486-0407

twilliams@business.nv.gov

Las Vegas, NV - April 10, 2014

Officials at Nevada
OSHA have issued six serious and two other-than-serious citations after
concluding an investigation into the tuberculosis outbreak that occurred at
Summerlin Hospital in May 2013. Penalties for the eight violations cited
totaled $39,600.

The agency initiated an
inspection after learning that at least two patients with unrecognized active
tuberculosis (TB) were admitted into Summerlin Hospital Medical Center for
treatment, one of which was admitted to the Neonatal Intensive Care Unity
(NICU). The infected patients received care by hospital staff, exposing
the employees to Mycobacterium tuberculosis. Subsequently, at least 20 employees
contracted TB and exhibited either active or latent forms of the infection.

A comprehensive
investigation of the incident was initiated to determine whether there was a
violation of Nevada OSHA safety and health standards or the general duty clause,
and any effect the violations had on the incident. The investigation
found multiple deficiencies in the hospital’s Tuberculosis Exposure Control
Plan.

SUMMARY OF CITED
VIOLATIONS

1. NRS
618.375(1), Serious citation- $6,300

a) At the time of inspection, Summerlin Hospital Medical Center’s
most recent Tuberculosis (TB) Risk Assessment did not include statistical data
related to a 2013 significant workplace exposure to Mycobacterium tuberculosis.
A TB Risk Assessment that included this data is necessary in order to properly
evaluate the quality of the hospital’s TB infection control plan, and identify
any needed improvements in infection control measures.

b)
Since the recent workplace exposure to Mycobacterium tuberculosis, Summerlin
Hospital Medical Center has not followed its own TB Exposure Control Plan that
states a “Risk Evaluation” will be conducted in the event of an exposure. Prior
to this inspection, Summerlin Hospital Medical Center did not conduct a
Tuberculosis (TB) Risk Assessment that included statistical data related to a
2013 significant workplace exposure to Mycobacterium tuberculosis.

2. NRS 618.375(1), Serious citation-$6,300

a)
At the time of inspection, Summerlin Hospital Medical Center’s Tuberculosis
(TB) Exposure Control Plan had not been reevaluated since the occurrence of a
significant workplace exposure to Mycobacterium tuberculosis. A reevaluation is
needed to identify and correct possible problems in TB infection control.

b) At the time of inspection, there was no requirement in
Summerlin Hospital Medical Center’s Tuberculosis (TB) Exposure Control Plan for
annual reevaluations, and the program was not reevaluated on an annual basis. A
yearly reevaluation is needed to identify and correct possible problems in TB
infection control.

3.
NRS 618.375(1), Serious citation-
$6,300

At the time of
inspection, Summerlin Hospital Medical Center did not have procedures in place
to ensure that employees who have been directly exposed to patients with
tuberculosis (TB) disease are screened for the infection as soon as possible
after exposure to Mycobacterium tuberculosis, or are provided follow up
screenings if needed. At least one hospital employee who had direct contact
with at least one of the infected patients was not given an initial TB
screening until eight weeks after the exposure.

4.
NRS 618.375(1), Serious citation-
$6,300

At the time of
inspection, Summerlin Hospital Medical Center’s Tuberculosis (TB) Control Plan
did not require prompt evaluations for all employees whose TB screening tests converted from negative to positive after exposure
to tuberculosis. At least eight hospital employees who had converted as
a result of this workplace exposure had to wait seven days or longer to receive
a chest x-ray to rule out active tuberculosis.

5.
NRS 618.375(1), Serious citation- $6,300

a)
Summerlin Hospital Medical Center does not conduct proper diagnostic measures
for patients who display signs of tuberculosis (TB). In 2013, at least two
patients with unrecognized TB disease were admitted into the hospital and cared
for by hospital staff, one of whom displayed signs of tuberculosis, presenting
with miliary TB with pulmonary involvement, but a sputum examination was never
conducted. Employees were exposed to Mycobacterium tuberculosis, subsequently
causing at least 20 employees to contract tuberculosis and exhibit either
active or latent forms of the infection.

b)
At the time of inspection, Summerlin Hospital Medical Center’s TB Exposure
Control Plan did not include all the significant symptoms that are indicative
of a tuberculosis diagnosis, nor did it require the administration of
subsequent diagnostic measures, such as a sputum culture, in the presence of
these symptoms.

6.
NRS 618.375(1), Serious citation-
$6,300

a) Summerlin
Hospital Medical Center did not initiate airborne precautions for patients who
display signs of tuberculosis (TB). When a patient displayed signs of
tuberculosis, presenting with miliary TB with pulmonary involvement, airborne
precautions were never initiated.

b) At the time
of inspection, Summerlin Hospital Medical Center’s TB Exposure Control Plan did
not require initiation of airborne precautions for all inpatients who exhibit
signs or symptoms of tuberculosis (TB) disease. The plan only addressed the
institution of airborne precautions for patients that are known or suspected in
the Emergency Room and Admitting Area. The TB
Exposure Control Plan also did not specify persons authorized to initiate and
discontinue airborne precautions.

7. 29 CFR 1904.11(a), Other-than-serious
citation- $900

In 2013, 20 employees of Summerlin Hospital Medical
Center converted to positive tuberculin skin tests (TST) and developed either
active or latent forms of a tuberculosis (TB) infection after at least two
patients with unrecognized TB disease were admitted into the hospital.
The employer did not record these 20 cases of occupational exposure to TB on
its 2013 OSHA 300 logs, which were certified by the employer as true, accurate
and complete on January 8, 2014.

8.29 CFR 1904.29(b)(7)(iv),
Other-than-serious citation- $900

Summerlin Hospital Medical Center did not ensure that
an employee who was potentially exposed to tuberculosis was entered on the OSHA
300 logs as a "privacy concern case.”
Employee privacy was not protected and the employee’s full name was listed for
Case #7161 on the 2013 OSHA 300 logs, which were certified by the
employer as true, accurate and complete on January 8, 2014.

The maximum penalty
that can be assessed for a serious violation is $7,000. Penalty adjustment
factors for employer size, gravity of the violation, good faith and history are
considered. The $6,300 penalty assessed for the serious citations for Summerlin
Hospital Medical Center takes into account a 10% reduction due to a clean
inspection history with no violations cited in two previous inspections
unrelated to the TB exposure.

Summerlin Hospital
Medical Center has 15 working days from the day the citation and proposed
penalties were received to remedy the violation and pay the associated
penalties or notify OSHA of their intent to contest the citation. Summerlin
Hospital may also request an informal conference to be held within the 15 day
period to receive further clarification or present additional evidence related
to the violations cited, discuss options to correct the workplace hazards or
enter into an informal settlement agreement.